Record Claim Statement

Please use this form to submit a preliminary record claim for a flight you’ve made. Please be sure to fill out all sections completely or your claim may not be properly processed. Claims must be received within 72 hours of completion of the flight. Please note that due to FAI restrictions, there can be no exceptions to this rule.

Record Claim Statement

*First Name:

M.I.:

*Last Name:

Company:

Position:

*Address (line 1):

Address (line 2):

Address (line 3):

*City:

*State/Province:

*Zip/Postal Code:

*Country:

*Home Phone:

Other Phone:

*E-mail:

* Type of record being claimed:
Speed Over a Recognized Course
Speed Over a Commercial Air Route
Other

* Your position on the flight:

If you were not the Captain/PIC, please indicate Captain/PIC’s name:

* Record being claimed:

* Start point (name):

* Start point Identifier:

* Finish point (name):

* Finish point Identifier:

* Date of Landing/Finish (please list UTC / "Zulu" date):

Airline (for Speed Over a Commercial Air Route records only):

* Aircraft manufacturer and model:

* Estimated performance or time en route (please approximate as closely as possible):

Click on the "Submit" button to transmit to NAA. A successful submission will result in a new message appearing in your browser and an automated email response being sent to you.

You must also telephone NAA at 800-644-9777 (or (703) 416-4888 extension 102) within 24 hours of submitting this record claim to confirm that it was received.